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2. This Application is to request to perform construction activities in the ROW such as utility work, road work, or driveway approach/sidewalk replacement. 

   If you are requesting placement of temporary scaffolding, construction fencing, window washing equipment, etc., that will cause a temporary encroachment upon the public right-of-way, Please fill out the Application For Temporary Encroachment of Public Right-of-Way form found here:

   • All contractors working within the Public Right-of-Way, must provide the following information to the City of Holland Transportation Department in order to obtain a permit Before Starting Work. 
   • Applications must be received 3-5 working days prior to the projected start date, unless it is considered Emergency work. 
   • Working in the Right-of-Way without first obtaining proper permits is subject to a Civil Infraction Ticket in accordance with the Holland Municipal Code and/or fees as listed in the Schedule of fees book.

   1. Complete application information (below) and attach sketches or plans of the work.
   2. Submit a traffic control plan for lane or full road closures for all major & some local streets.
   3. Submit proof of liability insurance listing “The City of Holland, its officers, agents and employees are named as additional insureds for general and automobile liability insurance.  Waiver of Subrogation is Applicable.”  The certificate holder must be the City of Holland, 270 River Avenue, Holland, MI  49423.   All subcontractors must submit the same proof of liability insurance.
   4. Indicate who is going to perform the restoration work.   If the City is to perform some or all of the restoration prior arrangements must be made and our rates shall apply and will be invoiced upon completion.  
   5. A standard 30-day permit is $150. Various additional rates apply depending on the project.  Please check our Schedule of Fees book (pgs. 71-76)  for details.
   6. All backfill materials shall be density tested according to MDOT specifications.   The Contractor shall be responsible for procuring and arranging the density testing and must submit acceptable density test results to Karen Elwood at k.elwood@cityofholland.com Failure to obtain density testing may result in fines and the ability to obtain permits for future work.
   7. Once the application is received and reviewed a link to pay via electronic check or credit card will be sent to the email listed on the application, unless the "mail invoice" box has been checked. 
4. Application Date*
   Application Date
6. Contractor Name*
8. Applicant*
9. Phone Number*
11. Email Address*
12. Upload COI
14. Description of the work*
16. Is this emergency work?*

    1. Yes

    1. No

    (Meaning it needs to be done in the next 24-48hrs, or needs to be done for the safety or health of the property owner)

18. Address of Job Site*
20. Start Date of Work*
    Start Date of Work
21. Completion Date of Work*
    Completion Date of Work

    This includes the installation and required restorations

23. Upload Sketch or plans
25. Will you be cutting into the road or curb?*

    1. Yes

    1. No

    If YES, You must include a traffic control plan with your application. A Traffic Control plan must be preapproved by the City Engineer.  

26. Upload Traffic Control Plan
28. What are the specific dates requested for the road/lane closure request?
    What are the specific dates requested for the road/lane closure request? Start Date

    —

    What are the specific dates requested for the road/lane closure request? End Date

    If differs than start & work completion dates

30. Will you be removing the City sidewalk or private driveway approach?*

    1. Yes

    1. No

    • If any sidewalk squares are to be removed and replaced for this task, we require that a professional concrete contractor be retained to do the replacement. Concrete sidewalk and approaches shall be placed meeting the City of Holland Standard Specifications for Sidewalk Installation. 
32. If you answered yes to either of the above questions, please list who will be doing and when will the following work occur: excavation, backfill work, aggregate base, asphalt patching, and concrete work. The City of Holland needs to be informed of these activities and have the ability to inspect the work at various stages to ensure compliance with MDOT Standard Specifications for Construction.
34. Payment for permit is required prior to permit processing. Upon receipt of this application, a link will be sent to the listed email for payment to be made online by credit card or electronic check. If the applicant would like to pay in person, please check this box to receive an invoice to bring in to City Hall with payment.

    1. Provide me with an invoice to pay in person at City Hall
36. Upon approval of your application, a permit and window card will be Emailed to the applicant, provided the applicant is in good standing with the City. An applicant in good standing is defined as one who promptly pays permit/restoration invoices, performs & submits density testing and has no history of working in the right-of-way without first obtaining the proper permit(s).

    
    

    Local companies that provide density testing services –

    Driesenga & Associates:  616-396-0255

    Materials Testing Consultants:  616-456-5469

    Soil & Materials Engineering:   616-406-1756

    Soils & Structures:  231-760-6841

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field